Inflammation-Induced CNS Glutamate Changes in Depression

• Status: Recruiting
• Trial end date: 2021-11-01
• Target enrollment: 0
• Participant gender: All

Summary

Increased inflammation has been implicated in the pathophysiology of a number of neuropsychiatric illnesses including mood disorders, which affect almost 30 million adults in the United States alone. One mechanism by which inflammation may alter behavior is through increasing brain glutamate, a neurotransmitter that in excess has been implicated in neuronal toxicity and resistance to conventional antidepressant therapy. The goal of the proposed research is to test the hypothesis that inflammation alters behavior through increasing glutamate in specific brain regions, ultimately leading to behavioral changes.

The proposed research is designed to determine the cause and effect relationship between inflammation and CNS glutamate as well as the relationship between CNS glutamate and specific symptoms. To accomplish these aims, investigators will administer a single infusion of either the tumor necrosis factor (TNF) antagonist infliximab or placebo (n=30 per group) to patients with high inflammation (CRP>3mg/L). A CRP>3mg/L was chosen because it is considered high inflammation according to guidelines by the American Heart Association. Moreover, a CRP>3mg/L is associated with significantly increased basal ganglia glutamate and with a clinical response to infliximab. Inflammatory biomarkers, basal ganglia glutamate as measured by MRS, and motivation and psychomotor activity will be assessed at baseline and days 1 and 3 and weeks 1 and 2 following infliximab or placebo administration.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Emory University
• Collaborator: National Institute of Mental Health (NIMH)
• Treatments: Infliximab

Criteria

Inclusion Criteria:

• Willing and able to give written informed consent

• Primary diagnosis of DSM-V MDD, current, or Bipolar, depressed type as diagnosed by the SCID-V

• Score of ≥14 on the Quick Inventory of Depressive Symptomatology (QIDS)-SR-16 or score ≥ 15 on the Patient Health Questionnaire 9 item (PHQ-9)

• Absence of significant suicidal ideation defined using the Columbia Suicide Severity Rating Scale - Screen Version (CSSRS)

• Off all antidepressant or other psychotropic therapy (e.g. mood stabilizers, antipsychotics, anxiolytics, and sedative hypnotics) for at least 4 weeks prior to the baseline visit (8 weeks for fluoxetine). No patients will be removed from their psychotropic medications for the sole purpose of participating in the study.

Exclusion Criteria:

• Autoimmune disorder (as confirmed by laboratory testing)

• History of tuberculosis (by history or as discovered by chest X-ray, skin testing or blood testing) or high risk of tuberculosis exposure

• Hepatitis B or C infection or human immunodeficiency virus infection (as established by laboratory testing)

• History of fungal infection

• History of recurrent viral or bacterial infections

• History of any type of cancer

• Unstable cardiovascular, endocrinologic, hematologic, hepatic, renal, or neurologic disease (as determined by physical examination and laboratory testing)

• History of any (non-mood-related) psychotic disorder; active psychotic symptoms of any type; antisocial personality disorder as determined by a clinician; substance abuse/dependence within 6 months of study entry (as determined by SCID)

• Active suicidal plan as determined by a score >3 on item #3 on the HAM-D

• Active eating disorder

• History of a cognitive disorder or ≤28 on the Mini-Mental State Exam

• Pregnancy or lactation

• Women of child bearing potential who are not using a medically accepted means of contraception

• Heterosexual males and their partners who do not agree to practice appropriate birth control

• Known allergy to murine products or other biologic therapies

• Chronic use of non-steroidal anti-inflammatory agents (NSAIDS), glucocorticoid containing medications or statins

• Use of NSAIDS, glucocorticoids, or statins at any time during the study

• Contraindication to MRI

• Previous organ transplant

• History of CNS trauma or active seizure disorder

• Highly treatment resistant depressed patients who score >5 on the Massachusetts General Hospital (MGH) Antidepressant Treatment Response Questionnaire (ATRQ) for current episode